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New York City's health commissioner ardently defended the city's decision not to evacuate hospitals and nursing homes before Hurricane Sandy, facing down withering questions Thursday from City Council members who contended that some old people may have died as a result.

The commissioner, Dr. Thomas A. Farley, said that the city and state health commissioners -- ultimately reporting to the mayor -- had made the best decision they could using information from the National Weather Service, which he said initially showed the brunt of the storm hitting Long Island Sound.

By the time on Sunday that it was clear the storm was threatening the city more directly, he said, ''We couldn't have accomplished the evacuation of everybody in Zone A before zero hour,'' which appeared to be as early as midnight.

After the storm, three hospitals -- Bellevue Hospital Center, NYU Langone Medical Center and Coney Island Hospital -- and several nursing and adult homes had to be evacuated unexpectedly because of flooding and power failures, with older residents and hospital patients having to walk or be carried down dark staircases. But Dr. Farley said that an advance evacuation would have been even more risky, perhaps leading to injuries or deaths. ''I'm not convinced in the end this was worse than what would have happened had a large-scale evacuation been ordered,'' Dr. Farley said. It was, he added, ''a judgment call.''

Jessica S. Lappin, a City Council member from the Upper East Side, interjected, ''So it was all or nothing?'' No, Dr. Farley said, the city had instructed long-term care facilities, like nursing homes, to evacuate patients who were dependent on electricity, like those on ventilators, and it had told hospitals to reduce their census by canceling elective surgeries.

He also said that hospitals had the option of making their own decisions to evacuate. ''In our experience with Hurricane Irene, hospitals did a very good job of evacuating on their own,'' he said.

But one problem was that while the state requires nursing homes to have evacuation plans, it does not require them to secure beds for the patients elsewhere, because it is hard to predict where the empty beds would be. Many patients displaced from storm-wracked facilities had transportation waiting but no place to go.

Dr. Farley said seven nursing and adult homes were so badly damaged that they are still closed, affecting about 1,200 patients. The residents of Belle Harbor Manor, an adult home in Rockaway Park, were taken from the Park Slope Armory to a location in East New York, and now are being housed on the campus of Creedmoor Psychiatric Center in Queens, Dr. Farley said in response to questioning from Brad Lander, a council member whose Brooklyn district includes Park Slope. ''We all recognize it is not ideal,'' Dr. Farley said dryly.

The commissioner insisted that over all, the city's judgment call had been the right one because, ''due to the heroic efforts of many people, no one lost their lives in health care facilities because of the storm.''

Some council members disputed that assessment, saying they believed that some deaths of old people that had been attributed to natural causes should actually have been ascribed to the storm. Dr. Farley said he was willing to look into any such deaths, but that the ultimate decision was up to the medical examiner, who had not confirmed those suspicions.

Two council members, G. Oliver Koppell of the Bronx and Peter Koo of Queens, pushed for the city to create a master list of old, sick and vulnerable people, so they could be more easily evacuated or ministered to in emergencies.